Peer-reviewed article
Linear growth trajectories in the first two years of life predict attained linear growth and stunting at five years: Results from the MAL-ED multi-country birth cohort study.
Md Ashraful Alam, S M Tafsir Hasan, Amena Al Nishan, Mustafa Mahfuz, Margaret N Kosek et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study followed over 1,400 children across eight countries from birth to five years to understand how growth patterns in the first two years of life affect stunting and height later on. Researchers identified five distinct growth trajectory groups, ranging from severely stunted growth to improved growth. Children who experienced severe growth faltering in early life had substantially shorter stature and higher stunting rates at age five compared to children with stable growth. The findings emphasize that the first two years of life are critical for preventing long-term growth problems.
Key points
- Five distinct linear growth trajectories were identified during ages 0-24 months: severely attenuated (9% of children), moderately attenuated (25%), mildly attenuated (34%), stable (25%), and improved (7%)
- Children in the severely attenuated growth class had 2.10 units lower height-for-age z-score at age five compared to the stable growth class
- Children in the improved growth class had 0.86 units higher height-for-age z-score at age five compared to stable growth class
- Early-life growth trajectories remained significantly associated with stunting and height at five years of age after adjusting for confounders
- Results were consistent across eight study sites in low- and middle-income countries
Limitations
This is an observational study that cannot determine causality or identify specific interventions that could alter growth trajectories. The study describes patterns of growth but does not test community-based interventions to improve early growth.
Abstract
BACKGROUND: Linear growth faltering and stunting are associated with increased childhood mortality and morbidity, as well as impaired physical growth and cognitive development. OBJECTIVES: We aimed to identify groups of children with distinct linear growth trajectories during their first two years of life and to determine whether these early-life trajectories were associated with attained linear growth and stunting at five years of age. METHODS: We used data from the MAL-ED birth cohort study for this analysis. Latent class growth modeling (LCGM) was applied to identify distinct classes of children who followed similar trajectories of length-for-age z-score (LAZ) from 0 to 24 months of age. Mixed-effects linear and logistic regression models were used to examine the associations between LCGM-derived trajectories and height-for-age z-score (HAZ) and stunting at age 60 months, respectively, with study site included as a random effect. RESULTS: We identified five LAZ trajectories among 1469 children aged 0-24 months, designated as follows: Class 1: severely attenuated linear growth (9%); Class 2: moderately attenuated linear growth (25%); Class 3: mildly attenuated linear growth (34%); Class 4: stable linear growth (25%); Class 5: improved linear growth (7%). In adjusted models, LAZ trajectories during the first two years of life were significantly associated with HAZ and stunting at five years. Compared with the stable linear growth class, children in the improved linear growth class had a predicted 0.86 higher HAZ at age five (95% CI: 0.67, 1.04), whereas those in the severely attenuated linear growth class had substantially lower HAZ at age five (β = -2.10; 95% CI: -2.26, -1.95). Similar associations were observed for stunting at five years. CONCLUSIONS: Linear growth trajectories during the first two years of life are critical predictors of attained linear growth and stunting at five years. Greater emphasis should be placed on improving early-life linear growth through community-based interventions.